Once upon a time there was adrenal fatigue
The term “adrenal fatigue” was coined in 1998 by James Wilson, DC. His adrenal fatigue theory correlated with Hans Seyle’s three-stage response to stress from the previous post. Remember these three stages:
- Alarm – adrenaline goes up
- Adapt – cortisol goes up
- Exhaust – when Seyle’s lab rats showed shrunken adrenal glands
Move over adrenal fatigue
Unfortunately “adrenal fatigue” is not a real medical condition, and it narrows our perspective to just the adrenal glands. Chronic stress does not make your adrenal glands poop out, so to speak. In fact, if you were at the point of exhaustion like the lab rats in Seyle’s experiments, with shrunken adrenal glands, you would have what is known as Addison’s disease, and you would be very sick, if not dead.
We now know that stress has an effect on many sites throughout your body, with complex feedback loops to your brain. When chronic stress leads to illness, it doesn’t happen in a linear three-stage process.
HPA-D – a functional medicine systems perspective
“Adrenal fatigue” is really about the communication between your adrenals and your brain, specifically your hypothalamus and pituitary gland. Chronic stress and dysregulated cortisol disrupt this communication.
The real clinical entity is called HPA-D, which stands for hypothalamus-pituitary-adrenal axis dysfunction. This more accurately describes the communication breakdown between your brain and your adrenal glands.
The way your body responds to chronic stress is a complex disruption of your HPA axis. You can have many different total and free cortisol patterns, and each one would be treated differently. In addition, you can also have problems with cortisol breakdown or metabolism.
Disrupted diurnal rhythms
You make over 50% of your day’s cortisol in the first 30-45 minutes you are awake – this is your cortisol awakening response (CAR). Your CAR starts before you wake up, then rises and peaks within 30 minutes.
You make the rest of your cortisol throughout your day, with an ideal deep drop in the evening, down to very low at night. This is the ideal cortisol rhythm.
This diurnal rhythm is perhaps the most important governing rhythm of your mind and body. It turns out that it’s often unbalanced in HPA-D. Examples include:
- Low morning cortisol (fatigue, sluggish wake-up)
- Low daytime cortisol (fatigue, dragging energy, poor immunity, inflammation)
- High evening cortisol (second wind, night-owl energy)
- High night cortisol (blood sugar dysregulation, insomnia, night wakings)
HPA-D affects all hormone rhythms
HPA-D affects your other hormone systems, including your thyroid, blood sugar, and sex hormones. Here is just an example of conditions that may have HPA-D as a root cause:
- High blood sugar, insulin resistance, and hypoglycemia
- Irregular menstrual cycles
- Hot flashes
- Night sweats
- Polycystic ovarian syndrome
HPA-D leads to tissue breakdown
When your HPA axis is hyper-activate, your body is in sympathetic overdrive. So, this means chronically elevated stress hormones, which causes body tissue breakdown. We call this a catabolic state, which can cause premature arthritis, osteopenia, osteoporosis, and other degenerative conditions. Many people do not realize these conditions are not natural and inevitable side effects of aging!
In the next post, you can read about HPA-D assessment, causes, and solutions.
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